Formulary Watch |

UTI scripts trend away from drug of choice

Fluoroquinolones and nitrofurantoin have surpassed trimethoprim-sulfamethoxazole (TMP-SMZ) as the most frequently prescribed antibiotics for uncomplicated urinary tract infections (UTIs) in women, according to a new national analysis. This is despite well-established recommendations (from the Infectious Disease Society of America and others) that TMP-SMZ is the drug of choice for UTIs due to cost and concerns about antibiotic resistance.

Three-tier benefit cuts Rx costs without unintended consequences

A three-tier pharmacy benefit can reduce prescription drug spending without increasing other medical resource use or fueling medication discontinuation rates. So concludes the fully published report of an analysis whose preliminary results were presented last year and reported by Formulary (2001;36:522). It is the first well-designed, controlled study to explore such consequences of three-tier benefits.

Study cautions against overtreatment when adopting new NCEP III guidelines

Clinicians must use caution in adopting newly revised national guidelines for treating elevated cholesterol, concludes a new study from the University of Maryland Pharmaceutical Health Services Research Department.

Investigational antiviral reduces duration, eases severity of viral respiratory infections

An experimental antiviral medication can shorten the duration of colds and reduce the severity of cold symptoms, reported Frederick Hayden, MD. He presented a pooled analysis of data from two phase III trials of the drug at the 41st annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), held recently in Chicago.

Update on the benefits and risks of hormone replacement therapy (PDF)

Emerging data are continually refining our understanding of the risks and benefits of hormone replacement therapy (HRT) in postmenopausal women. This review assesses the current state of evidence on these various risks and benefits, concluding with an outline of what's established and where varying degrees of uncertainty remain. Algorithms for use of HRT for several established indications are featured.

Drug development gets budgetary boost as regulatory updates start to emerge

While government agencies and private health plans struggle to deal with rising pharmacy bills, the federal government is expanding support for biomedical research and FDA

Pharmacy services in an ambulatory FFS setting can increase physician revenue

Idaho State University, Pocatello-Evidence in the literature has suggested that a pharmacist-run clinic provides quality care in chronic disease state management. In addition

Success of a P & T policy for use of a second ACE inhibitor before switching to an ARB

VA Medical Center, Miami-ACE inhibitor therapy is recognized as the gold standard treatment for congestive heart failure (CHF) as well as diabetic nephropathy due to its effect on the morbidity and mortality associated with these conditions.

Ortho Evra (Norelgestromin/ethinyl estradiol transdermal system) Ortho-McNeil

New combination, NME as component: Weekly contraceptive skin patch

Focalin (Dexmethylphenidate HCL Tablets) Novartis

New formulations: Single isomer form of methylphenidate for treatment of ADHD

Coreg (Carvedilol Tablets), Glaxosmithkline

New indication: Beta blocker cleared for severe HF

Xigris (Drotrecogin Alfa, Activated) Lilly

Biologic: Biologic for adults with severe sepsis at high risk of death

Tracleer (Bosentan film-coated tablets) Actelion

NME: First oral agent for treatment of pulmonary arterial hypertension

Pharmacy costs and controls loom large in cash-strapped 2002 policy agenda

As health care costs and pharmaceutical expenditures continue to climb, the effect of these trends on health care coverage and economic development is emerging as a central issue for 2002.

Kineret (Anakinra) AMGEN

Biologic: First IL-1 receptor blocker for moderate to severe rheumatoid arthritis

Invanz (Ertapenem for injection) Merck

NME: Once-daily injectable carbapenem for treatment of various infections

Bextra (Valdecoxib tablets) Pharmacia/Pfizer

NME: COX-2 inhibitor for rheumatoid arthritis, osteoarthritis, and dysmenorrhea

Acute migraine therapy: Triptan quantity limit maintains total health care savings 1 year out

Prime Therapeutics, St. Paul, MN-Do quantity limits on abortive migraine medications (ie, triptans) and educational efforts to increase the use of prophylactic therapy reduce total health care costs over the long term?

Conversion to a computerized clinical intervention documentation process: What are the gains?

ValleyCare Health System, Pleasanton, CA-The expansion of decentralized clinical pharmacy services at this health system served as the impetus to improve their clinical intervention documentation process.

Infliximab and etanercept largely comparable in two real-world rheumatoid arthritis studies

Two new real-world comparisons of the tumor necrosis factor (TNF) blockers infliximab (Remicade) and etanercept (Enbrel) show that the two agents are highly comparable treatments for rheumatoid arthritis

Humana launches Web-based tool to alert members to low-cost alternative drugs

While tiered benefit plans aim to spur use of lower-cost alternative drugs, they may leave patients in the dark about what those alternatives are and how much out-of-pocket savings they can bring.

Ranolazine enhances exercise performance when added to standard medications

Ranolazine, the first in a new class of antianginal agents called the partialfatty acid oxidation (pFOX) inhibitors, improves exercise performance andreduces angina frequency in patients who still have symptoms despite treatmentwith other antianginal medications, according to Bernard Chaitman, MD. Hereported the results of a Phase III study called the Combination Assessmentof Ranolazine in Stable Angina (CARISA).

For first time, an antianginal agent shown to improve clinical outcomes

An agent developed specifically for the treatment of angina reduces theincidence of major coronary events, reported Henry Dargie, MD, who presentedthe results of a trial known as the Impact of Nicorandil in Angina (IONA).It is believed to be the first large-scale trial to report on the effectsof a specific antianginal drug on clinical outcome.

Statins found beneficial in wider range of patients, major study finds

Anaheim, CA-The largest trial of cholesterol-lowering therapy ever conducted extends the current indications for statin therapy, reported Rory Collins, MD.

Real-world study finds "unequivocal"lack of difference among SSRIs

The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, sertraline,and paroxetine are equally effective and tolerated in depressed patientsacross a broad range of outcome measures. So finds an open-label, randomizedstudy in 573 patients treated for depression for 9 months in a primary caresetting.

Step-down therapy suceeds in most GERD patients

A step-down approach from proton pump inhibitor (PPI) therapy is successful in most patients with uncomplicated GERD, reducing costs without compromising quality of life. So concludes a new prospective study.

Meta-analysis reveals only small differences among triptans

Differences among oral selective serotonin agonists (triptans) are small but clinically relevant for the individual patient, according to a comprehensive meta-analysis.

Pipeline Preview

Pipeline Preview for January 1, 2002

FDA Actions in Brief

FDA Actions in Brief as reported January 1, 2002

Application of probabilistic sensitivity analysis in decision analytic modeling (PDF)

Although sensitivity analysis is a widely used technique for testing the uncertainty in pharmacoeconomic modeling parameters, it does have limitations. This month's column introduces probabilistic sensitivity analysis as an alternative method for examining uncertainty.